Claudia Krywiak
Over the last 40 years, the average age of first time parents in Canada has risen steadily. More Canadians are waiting until their 30s or even 40s to start a family, often to focus on careers, education or financial stability. But biology hasn’t changed. Fertility declines with age and waiting longer can make it harder to conceive. That’s leading to more couples facing unexpected challenges in growing their families today. Advances in reproductive technology and Genomics are offering new options, but access, affordability and awareness remain barriers for many. So how can innovation help Canadians complete their families and shape the future of reproductive health? Welcome to Where Next Happens, a podcast sharing stories of Ontario’s innovators and entrepreneurs. I’m Doctor Claudia Krywiak, president and CEO of the Ontario Centre of Innovation. Joining me today are Jeremy Grushcow, co-founder of Juniper Genomics, and Kaylene Ready, chief product officer and genetic counselor. Juniper develops reproductive genetic testing and digital tools that help people make informed decisions about fertility and family planning. Jeremy leads the company’s vision and strategy, while Kaylene applies her expertise in genetic counseling and product development to ensure these tools are practical and patient focused. Welcome to both of you.

Jeremy Grushcow  

Great to be here. Thanks for having us.

Claudia Krywiak

So to get started, Jeremy, let’s start with the origin story. Can you tell us a little bit about your background and how you co-founded Juniper Genomics?

Jeremy Grushcow  

Sure. So, Juniper is something that I’ve been thinking about for a long time. Shortly after the Human Genome Project finished, in the mid 2000, people were thinking about how we were going to use the genome to best improve human health. And one thing that I wrote about at the time was this idea that in IVF, if we’re lucky, we end up with a set of embryos, and the opportunity to choose among those embryos would be a really powerful time to use everything that it’s possible to genetically understand about the future of that embryo. And I think that idea has always been really compelling for me. As you know, my career progressed and as our understanding of the genome progressed and as our understanding of how to use that data improved over the last 20 years.

Claudia Krywiak

And, Kaylene, how did you get involved?

Kaylene Ready

So I learned about juniper about a year ago. I am trained as a genetic counselor, and I’ve worked in product for 15 years and was looking to make a move and learned about Jeremy and Juniper and what they were doing, and I was instantly hooked. Right? It just as Jeremy said, it’s this moment when you can make a new decision and really empower patients with more information and hopefully get them to a pregnancy faster.

Claudia Krywiak

We’re seeing that Canadians are having children later in life. What trends are you seeing in terms of fertility challenges and how does that compare globally?

Jeremy Grushcow  

Yeah, I think, you know, that’s definitely something that we see globally. I think delayed childbearing is highly correlated with, economic advancement in society broadly. And I think, you know, tons of social benefit has come from that. And biological challenges have come from that. And I think there’s biological risk that comes from delayed childbearing, both from women and from men. I think we’re used to talking about declining female fertility with age, because it’s one of the easiest things to measure. It shows up in at the chromosome level, which is very easy to observe. But there’s declining male fertility as well, both because of delayed childbearing and, you know, potentially because of environmental factors that are affecting sperm count and quality. So we see lots of risk that comes from the male side. And 45 year old dads contribute twice as much genetic risk to their embryos as 25 year old dads. So there’s definitely this is you know, genetics is no exception in the world of reproduction, where delayed childbearing really creates increased risk from both parents in terms of the ability to form embryos that are going to succeed during development.

Claudia Krywiak

So can you walk us through how the Juniper Genomics technology works, and how it’s helping to address some of these challenges related to fertility?

Kaylene Ready

Okay, so we have to do my analogy because I love this. The way that I explain this to patients is that when you’re going through IVF and you make embryos, if we don’t do any testing of those embryos, we don’t look at the genetics at all. There’s about a 30% chance that when you transfer those embryos that you will achieve a pregnancy and more importantly, a live birth.

Claudia Krywiak

Just 30%.

Kaylene Ready

Yeah. And that’s because of the things that Jeremy just mentioned. There are issues with chromosomes and other genetic mutations, which is why genetic testing is really important. And so what we can do is take a few cells off of the embryo, and that doesn’t harm the embryo. And we can look at those and do genetic testing of those. And the first thing we can do is look at the embryos chromosomes. The analogy I like to use is if you imagine your embryo is like a bookshelf and the books on the bookshelf are your chromosomes. What we’re doing is we’re just counting those books on the bookshelf. You want to have 46. And so if you do that type of testing, you can increase your chance of pregnancy and give birth to about 50 or 55% coin flip. What we’re doing at juniper is taking that even a step further. So rather than just stopping it, counting those books, we’re going to take every book off of the bookshelf. We’re going to read it cover to cover. And what we’re doing is looking for genetic diseases that might affect the child’s eventual health, but also we’re looking for variants that might affect the embryo’s viability. And our goal is to increase that first transfer rate from that coin flip to about 80 or 85%.

Claudia Krywiak

That’s a great analogy that that really shows the impact that this technology can have. But it also, I think, demonstrates what a challenging space you’re, you’re in where you have deep science that you’re translating from the research lab into the marketplace and the impact that it can have. So let’s talk a little bit about some of those those challenges. And I think one one of the first ones is when we look at reproductive technology, there are significant kind of ethical and societal considerations as well. And I think our audience would like to hear a little bit about that, because first and foremost, this is something that you do need to address along your commercialization journey as you bring this technology, this very powerful technology to market.

Jeremy Grushcow  

Yeah. The good news about that is that we don’t require a whole new ethical framework. We’ve had a very robust framework for medical ethics in place for the last, you know, 70, 75 years. and so when new technologies come along, our job is to do an intellectually honest and rigorous job of applying that framework to a new technology and understanding what. Responsible uses are and the principles, the bedrock principles of that are the same as they have been for a long time, which are autonomy, beneficence, and justice. And so we’ve thought very carefully about those things as we’ve brought juniper into into the market. And, you know, there’s a lot of nuance to all these conversations. But putting patient autonomy first is incredibly important, allowing patients to have access to their data, to own their data, to understand their data and to make their own decisions. And I think this is really sort of the core of what juniper is able to do is this is a decision that’s being made every day has been made since the beginning of the in vitro fertilization. Right. Which is which embryo are we going to transfer, which embryo we’re going to transfer first? Which embryo has the best chance of success. And we’ve been making that information with more and more data as the field has progressed over the last 40 years. But the nature of that decision is not different. And the people who are supposed to make that decision and the way they’re supposed to make that decision hasn’t changed, which is to give them data that is medically valid and to allow patients and their clinicians to make individual decisions about what they’re doing on their reproductive journeys. And so that’s really the core. You know, what we’re able to do at juniper is just add more information to this decision that’s already being made and to empower patients to give them, hopefully, more clarity and confidence when they make that decision.

Claudia Krywiak

So in terms of the the type of talent that you need to attract to the company. So, Kaylene, you said your background is in genetic kind of counseling. Of course, there is significant kind of technical talent in the company as well. But what about on the bioethics side as well? Is that the type of talent that you also need to attract if you’re in this type of space?

Kaylene Ready

Yeah, definitely. And I think, you know, Jeremy could speak to we have a scientific and clinical advisory boards and one of those people is a bioethicist by training. And so that is really important to us. I will also add that, you know, part of my training as a genetic counselor is in ethics and thinking about using genetics and appropriate ways in the in the medical community.

Claudia Krywiak

So let’s talk a little bit about the commercialization path. How do you take a technology like this and bring it bring it to market. So who are your customers? How do you start working with clinics? Is it the patients that are your customers? Is it the clinics? Is it the health care system? talk a little bit about the commercialization journey, specifically in this space.

Jeremy Grushcow

It’s a really interesting space on the commercialization side, because there are a lot of paths to getting to market in in the IVF space in Canada and in the US. IVF is still the vast majority of IVF is a private pay market, right? In Canada, there are some covered cycles in the US. there are both specialized and generalized insurance providers who provide some coverage for IVF. But, you know, 70% of couples that undergo IVF incur debt to do it. You know, this is this is individual families, you know, spending a lot of their own money on a difficult and invasive and challenging journey. And I think on the flip side of that, there are not a lot of barriers to offering them products in this space. Right. A lot of it is there’s a lot of direct to consumer marketing. There’s a lot of, like, we are we’re a lab developed test. Right. The barrier to entry is a clinician orders to test, and we perform it in a regulated lab. Right. Very little of IVF because it’s so bespoke is a, you know, a standardized or or an FDA or a Health Canada regulated process and that really shifts the burden to clinicians and I think to, to companies to assure themselves what they’re offering is going to help people on that journey and provide value on that journey and that’s really the justice part of what we talked about earlier is like, are we, you know, beneficence, are we really helping? Are we providing it to people in a way that, that is as equitable as possible? So our path, because we take that responsibility really seriously, is rather than try to sort of create advertising and sell direct to patients in the IVF space, we want to offer something that clinicians are building in as part of their standard of care, as part of their practice that they believe and are willing to recommend, based on the evidence that we’ve generated, is going to help patients on on their journey. And so our our business model in the space is a really a B2B model where we are partnering with IVF clinicians, to recommend this to their patients, to offer this to their patients, even though ultimately it’s patients who are making the the purchase decision and who are, you know, in, in their autonomy responsible for, for choosing the embryos that they want to transfer.

Kaylene Ready

I was going to add, I think part of that, right, that B2B model and working with clinicians who have science backgrounds is generating data and really being transparent about what we know, what we don’t know. And then, you know, presenting that data at national conferences so that we’re all on the same page. So that’s really been, I think, a critical part of of our commercial plan.

Claudia Krywiak

And currently is your technology in clinics in Canada, in the US, elsewhere?

Jeremy Grushcow

Yeah, we’re we’re available at clinics both in Canada and the US. We launched just a few months ago commercially.

Claudia Krywiak

Congratulations.

Jeremy Grushcow

Thank you. And and you know, thank you. Thank you at OCI for helping us make it this far down the path. But it’s been incredibly gratifying. You know, we are we are starting to see clinical outcomes that we’re excited about, where we are getting patient feedback that we are incredibly proud of. And, you know, our clinical partners are starting to use us more and more, both within their practices, and more and more clinicians are coming to us to help them give their patients that clarity and confidence that we’re trying to provide.

Claudia Krywiak

And I know it’s it’s still early days, but what kind of feedback are you hearing from doctors and families?

Kaylene Ready

I mean, really overwhelmingly positive, especially from patients. We recently met with a patient who is going through IVF and was struggling. We found something. Honestly, it was not the result she wanted, but it provided her clarity with how to move forward. And so that was the kind of feedback she gave us is like, look, this was hard news to get, but I was otherwise just going to keep kind of doing what I was doing and not being successful. And I’m so grateful for what I learned through through your test. So we’re getting that kind of feedback, which just like it, still gives me chills. It’s amazing.

Claudia Krywiak

That is a very powerful example because that’s the power of data, the power of science. It provides clarity and it provides the opportunity for a path forward.

Jeremy Grushcow

I think it’s so important in this space because in the absence of that data, we have these really, I think, toxic social narratives of, you know, you just have to try harder. Right. You’re not doing it right. Even the you know, the word miscarriage implies that, you know, someone has done something wrong in carrying a pregnancy. And you know what? What really brought us to this point as a company is, is digging into this data behind failed transfers, in IVF, behind pregnancy loss and saying, listen, this is not about a mom doing something wrong. This is about embryos not being viable in the first place. And so, you know, we really need to replace these social narratives with this data and that it’s going to change the outcomes of these journeys, but it’s all going to change the emotional tenor of the journey. And I hope it changes the narrative for people going through these journeys to just be able to say, it’s really hard to let yourself off the hook if you don’t have that data.

Claudia Krywiak

That’s an impact that’s often overlooked that the the tremendous not only financial but emotional toil that this journey takes on many couples and to empower them with information and with data is is really, really impactful. So you say that you’re working both in clinics in Canada and in the US, and we’ve spoken to companies that are in a similar space, but their technologies are typically reimbursed in Canada, or that’s the aim to get them reimbursed under the public health care system. And they often struggle getting that technology into that, into that system. I know this is a slightly different case here. Do you see a difference with the clinics that you’re that you’re working with here versus in the US? You know, who are the early adopters, the first customers or because you’re actually working mostly outside of the publicly funded system there is no difference?

Jeremy Grushcow

Structurally, there’s not a lot of difference. I think that, like many things where there aren’t a lot of structural differences, just the numerical difference changes the equation a little bit, where there just are more early adopter clinics in the US than there are in Canada, because there are more clinics in the US than there are in Canada. But I don’t think that there are. I don’t think there are big structural differences in the way that people approach this care. I will say, you know, the Ontario government’s approach to IVF has been very interesting in that there’s no like a tax credit that’s going to be available.

Claudia Krywiak

Yes

Jeremy Grushcow

That’s pretty broad in terms of what’s reimbursable, I think under that tax credit. And so I think that gives patients I really what I like about that is that it gives patients a lot of autonomy in choosing, you know, what they choose in choosing how they go through this journey and what’s important to them as part of that journey. And I’m interested in seeing how that impacts the pathways to care. I think that people received in Ontario will have some interesting data on that versus other provinces that are taking a different approach to funding IVF versus, you know, different payer systems in the US where, you know, some of the insurance companies that cover this cover it in a very prescriptive way, and some of them cover it in a very flexible way. And, you know, we’re learning about all of that as as we start to work with patients and clinics about how they navigate that and how they value different parts of their journey.

Claudia Krywiak

What advice would you give to someone starting out in, in, in the, in this space? So biotech very, very deep science and translating that that science into impact and improved patient outcomes. What have you learned along the way and and what advice would you give and what would you do differently if you had to do it all over again?

Jeremy Grushcow

Well, Kaylene, you should start this one because you’ve actually done this more times than I have.

Kaylene Ready

I think the most important things in this space are transparency, really being clear with the clinicians and with patients about what you’re doing and what you know and what you don’t know. I think the other important thing that I’ve said in other places is, you know, you might have the most amazing idea, but until you go and spend a day, a week in a clinic and really learn how that clinic works and understand their workflow, you don’t have a chance. You’ve got to understand where you fit in terms of ease of use, regardless of how amazing your idea is. And you have to have both of those things, I think to be successful in this space.

Claudia Krywiak

And Jeremy, what about you?

Jeremy Grushcow  

I mean Kaylene nailed it. I guess.

Kaylene Ready

You scared me. And I just have babbled this over and over for, like, a year or so.

Jeremy Grushcow  

Yeah. I mean, I mean, it’s absolutely my experience in this and most of my startups before this were in drug discovery. And so this, you know, working in sort of, clinical practices is definitely a different space for me, and I think that’s absolutely true. I mean, I think it’s it’s true in any startup. Is that like, it’s it’s this really interesting pair of things to hold in juxtaposition as a founder that on the one hand, you have to have this, like, wildly unshakable conviction in your vision, right? Because if you didn’t have that, you would never survive with the first two weeks of starting the company. And on the other hand, you have to have this like, I’m gonna I’m gonna say the word humility, which people who know me will laugh at me saying, but like, you have to have this. You have to hold this uncertainty. You have to you have to hold the opposite of that certainty. Like you have to have real conviction in what you’re trying to accomplish. And also like incredible flexibility in how you accomplish it. And and you have to listen to, your team, you have to listen to patients. You have to listen to clinicians. because if you if you’re rigid about the ways that you imagine things are going to turn out, you’re going to fail immediately. Like, Kaylene’s 1,000% right about that. And then the thing that I would add that I think is obvious to everyone who’s been listening, so far, is that you need an unbelievable team of people around you, and you have to surround yourself with people who are smarter than you are, which I have succeeded at phenomenally. And you have to, you know, you have to pay attention to them and their experience. You have to listen deeply. if you’re really lucky, you get to work with an amazing group of people and accomplish something really meaningful.

Claudia Krywiak 

And and you’re right, this does apply to to startups across all all sectors and clean, especially that notion of really understanding, in this case, the workflows in the clinics and how that actually works. We were having a discussion with a startup in a completely different sector. It was AG tech, and she had the same advice like, go work in a greenhouse, go understand the workflows in a greenhouse. It doesn’t matter how amazing your technology is until you have that understanding of the of of how the end user is operates. It’s not enough just to have the technology. So how do you fundraise in a space like this? Is it difficult to, raise financing? OCI was was involved in your pre-seed seed stage? financing? How difficult is it to find investors in this, in this space? Or how easy is it to find investors in this space?

Jeremy Grushcow

I think it’s almost impossible to answer that question without, you know, inhabiting the confirmation bias. That’s that’s inherent in being where we are, right? Like, it’s incredibly hard. I like, you know, I and I know people for whom it’s incredibly easy. I think there’s so many factors that go into it. I think the only thing that I would reflect on and say is that none of what you read on LinkedIn is going to apply directly to you. There’s I don’t think there is a single formula for succeeding at this. I think there are many reliable formulas for failing at it, you know, that generally involve, like, not listening to anybody. But no, I think, I don’t think there is a single path or a right or a wrong way to do it. You know, there were moments when our fundraising journey was like incredibly, rewarding and went very smoothly. And there were times when it was incredibly challenging. And, you know, I worried about whether we were ever going to bring this to see the light of day.

Claudia Krywiak  

And where did your first investors come from? Where did you meet them?

Jeremy Grushcow

I was very lucky in that, in that, you know, our first fundraising came literally from friends and family. And I had, you know, the privilege and the good fortune to have a group of literally friends and family who knew me and believed in my ability to do this and believed in the vision that we were putting together. From the very earliest days. We’ll say alongside that, a couple of investors, you know, at, Velocity, who took a very early bet on us institutional investors. Velocity, Hedgewood in Canada. Both were, you know, early institutional check writers that I, you know, very grateful for. But the vast majority of it was was literally friends and family and was just really lucky to have those people in my life.

Claudia Krywiak

So what’s next in terms of juniper, like what’s on your horizon in terms of milestones you need to hit and when? Where do you want to see yourself 12 months, 24 months from now?

Jeremy Grushcow

Kaylene, you want to start up on that one?

Kaylene Ready

Well, let’s say it’s your company. I think the most important things are to continue to, you know, work with clinics and serve our patients. On top of that, I think, you know, we want to continue to reinvest in the testing that we’re offering. So really thinking about what are the ways we can do what we’re doing even better. What are the different things we can add to the test we have, and what are the adjacent tests that would be helpful in this space? We keep hearing from our clinicians that one of the things they’re really interested in is almost like an infertility panel for the parents even before,  you know, go into doing IVF.

Claudia Krywiak

Oh Interesting.

Kaylene Ready

Yeah. So really, you know, trying to again, listen to your customers and think about how to make those things a reality. I’m sure Jeremy has a good like, CEO answer for this, but.

Jeremy Grushcow

Yeah I mean listen I…

Kaylene Ready

The product person has a product answer.

Jeremy Grushcow

Yeah, we can rattle off numbers, but I think, you know, I think all the things we’ve been talking about like just continue to help more and more patients, clinicians find this clarity and confidence. I think, like the more certainty we can provide about, you know, successful embryo transfers, there really is a massive emotional shift In this journey for people, you know, there’s so much anxiety and uncertainty that are part of the journey today. And if like if you’re asking me like, what’s my goal for juniper and my goal for Juniper Genomics and and for us as a team and for the patients clinicians we work with, is to start to shift that emotional experience a little more towards joy, to give people enough confidence that maybe there can be a little bit more joy in this part of a family journey. I would love that.

Claudia Krywiak

That that’s really powerful, because when people think of the IVF journey, joy is not a word that they would associate with it. There is a lot of anxiety and a lot of pain and a lot of hardship that that’s associated with it. And, you know, Kaylene, when you talk about some of the potential products down, down the line before you start that journey, perhaps having a panel or information or data. That’s also a very powerful tool to have, because the reality is, up until now, many people have started that journey without any information at all, and if they had information at the outset, it would certainly improve outcomes, but also lessen a lot of the emotional toil that this, that, that, that this takes.

Jeremy Grushcow

I think that’s exactly right. I mean, I think that’s, you know, even when patients are not getting the answers that they want, the idea that we are saving them from, you know, you know, constantly just hitting a wall, you know, and not and not knowing why. But, you know, even for patients who come to us right from the beginning to be able to give them more certainty about what that path is going to look like, I think that’s where so much of the anxiety comes from, is feeling that, you know, you don’t have real agency over this journey. It’s happening to you. And, and the idea that you have no idea how it’s going to go or what to expect, because a clinician in New York, just wrote a book called The Lucky Egg, and it’s sort of a play on her name, which is Sekhon, but also because it feels like there is this just a lot of a feeling of, I think rolling the dice on on this journey and like to try to give people a little bit more control back a little more, more agency back. And on that journey.

Kaylene Ready

I mean, I’ve found consistently in genetics, right? Again, you don’t always get the news you want, but being able to provide some kind of anticipatory guidance or a diagnosis or those kinds of things are really meaningful to patients and families. And right now, 1 in 3 couples, even with, you know, funded cycles drop out of IVF, because that emotional toll is really high. So, you know, being able to provide that information is critically important to helping them kind of achieve their family dreams.

Claudia Krywiak

And Juniper’s working on the leading edge in terms of advanced advancements in reproductive genetics. Where do you see this sector going? And with all of the advances in AI, is that going to make a difference and have an impact? Give us a sense of of kind of is the sector in the middle of kind of accelerated technological advancement? Is it just at the beginning? and what can Canadians or people in general expect in the next ten years?

Kaylene Ready

I. Yeah. Go ahead.

Jeremy Grushcow

Oh, thanks.

Kaylene Ready

I know.

Jeremy Grushcow

Okay. So there was absolutely, like a real golden age of IVF technology improvements from about 1990 to about 2010, where, you know, success rates went from about 10% to about 50%. you know, for, for transfer and for massive different a number of different components of that at the time. Unfortunately, things have been pretty stagnant since then and pretty stay or else or stable, I guess would be a kind of way of saying. But I think we are entering a new golden era of IVF. I think that what we’re doing at juniper, I hope, is going to be a big contributor to that. but I think, like the broader availability of data, the broader ability to analyze that data both by, you know, traditional data science and through AI, I think those can be very powerful. At Juniper, we’re starting with the the causal pieces that we can understand, and trying to use that as a foundation for understanding the rest of the process as much as possible. So both understanding where parental risk comes from, but also understanding like when an embryo fails in the lab, can we distinguish things that are about lab process from things that were inherent in the embryo to begin with? When you make transfer decisions that are related to maternal factors, are those maternal factors actually causing the different outcomes, or are you looking at noise caused by different embryo outcomes. Like, once we have a baseline of understanding embryos that are able to succeed. It’s a platform that’s going to help allow us to partner with many other companies in this space, to understand all of the other things that cause success and failure, really optimize as much as possible every step of the IVF process. And I think that’s what we’re really excited about over the next decade for infertility and fertility families.

Kaylene Ready

I also think there’s a lot of opportunity with AI used appropriately, but to be able to scale care a little better. Right. The your average patient does not have good access to an infertility clinic that is related to cost. But even if we flipped a switch and just covered the cost for everybody tomorrow, you wouldn’t be able to get an appointment. So really thinking about how do we scale that care and get this kind of information to more people, I think is is another important piece of the puzzle.

Claudia Krywiak

And I think what that really says is This is a very hopeful moment in time where advances in technology, advances in AI, in data science, in biotech have the potential to unlock opportunities for people who are trying to have families who previously may have had to undergone a very undergo a very difficult journey that may have not ended up successfully. So it’s a very hopeful message for for this, for this moment in time. Thank you so much, Jeremy and Kaylene. It’s a pleasure to talk with you. And I am so excited that you have hit a commercialization milestone and the technology is being deployed in clinics and most importantly, the impact it’s having on on families in North America. Congratulations. And, thank you so much for taking the time to join you today.

Kaylene Ready

Thank you

Jeremy Grushcow

Thank you for having us. Thanks, OCI, for making such a wise bet.

Claudia Krywiak

That’s it for this episode of Where Next Happens. To learn more about Juniper Genomics, visit junipergenomics.com. Where Next Happens is produced by the Ontario Center of Innovation. This episode was produced by Jasmine Rach, edited by Gaetan Harris. Amanda Cupido is the executive producer and I’m your host. Doctor Claudia Krywiak. Ready to take your idea to the next level? The Ontario Centre of Innovation helps innovators access the funding, mentorship and resources they need to drive the future forward. Visit oc-innovation.ca/podcast to learn more.